The Jakarta Post
As medical workers treat more and more COVID-19 patients, concerns are growing over how to deal with the medical waste that is expected to pile up.
The virus spreads from people to people through droplets from infected persons. It is unclear how long the virus from the droplets survives on surfaces, but various studies suggest it may persist up to 72 hours on hard shiny surfaces and up to 24 hours on porous surfaces depending on the temperature and humidity.
According to data from the Health Ministry, 2,820 hospitals and 9,884 community health centers (Puskesmas) in Indonesia produce up to 290 tons of medical waste every day. There are 10 licensed medical waste processing plants in Indonesia with a total combined capacity of 170 tons of waste per day, meanwhile only 87 hospitals have incinerators to process waste on site, with a combined daily capacity of up to 60 tons.
There is no data on how much medical waste is being produced as a result of COVID-19, but the Environment and Forestry Ministry predicted that medical waste would increase during the pandemic, particularly from the use of protective gear and other single-use medical equipment. Not to mention the medical waste from the 132 referral hospitals for COVID-19 patients and the increasing public use of face masks and gloves.
“This pandemic is still developing,” the ministry's waste management director general Rosa Vivien Ratnawati said.
In response, the ministry issued on March 24 a circular on infectious waste and household waste management during the pandemic, detailing mechanisms for central government and regional administrations to prevent COVID-19 waste buildup.
It recommends methods to dispose of waste from health centers, waste from people under surveillance (ODP) under home care and regular household waste with disposable face masks and other protective gear.
It says that "infectious waste" from health facilities must be collected from closed containers at least once every two days. The waste must later be destroyed using an incinerator or autoclave with a shredder function. The residue left after the processing must be labeled as hazardous waste (B3) to be later transported to a hazardous waste processing plant.
Activists have warned that excessive use of incinerators might contribute to air pollution, but the ministry said it was the most efficient technology so far to process the potentially infectious medical waste.
“Therefore, the incinerators must also be equipped with air pollution control devices so the emissions produced are still in accordance with prevailing standards,” Rosa said.
The Environment and Forestry Ministry is assisting the Health Ministry in preparing hospitals for better disposal of COVID-19 medical waste.
It has also urged people to take care of their own waste, especially single-use face masks, which should be disposed of properly by tearing or cutting them before throwing them into a closed container to prevent them from being reused.
Jakarta, which has recorded the most cases of COVID-19 to date, has placed special bins for used masks in temporary disposal sites (TPS) across the city, in line with the environment ministry's recommendation.
“As for residents using disposable face masks, they should place the used masks in a separate container -- which would then be collected by sanitation workers and then processed or demolished by a third party hazardous waste processor,” the Jakarta Environment Agency’s hazardous waste division head, Rosa Ambarwati, said.
In West Java, authorities have enlisted PT Jasa Medivest, a company specializing in medical waste disposal and a subsidiary of province-owned PT Jasa Sarana, to process medical waste produced across the province.
West Java Health Agency head Berli Hamdani Gelung Sakti has also called on residents to properly dispose of face masks and gloves to prevent infection.
But activists are adamant that burning medical waste could harm the environment.
“Not all medical waste should be burned in incinerators, and it could increase dioxin and furan air pollutants that can cause cancer,” Daru Setyorini of the Environmental Conservation Organization (ECOTON) said. “The Health Ministry could increase use of autoclaves for medical waste like gloves, hazmat suits, IV [intravenous solution] bottles and face masks.”
Yuyun Ismawati of environmental health NGO the Bali Fokus/Nexus3 Foundation said “misconceptions” about methods of onsite waste processing at healthcare centers were rampant, with many people assuming that all medical waste must be burned immediately.
The organization found that only 69 hospitals in 19 provinces had permits to process hazardous waste. Of the number, 23 hospitals are in East Java, followed by West Java, Central Java and Jakarta with five hospitals each. North Sumatra, East Kalimantan, South Kalimantan and South Sulawesi each have four, and the remaining provinces have one to three such hospitals each. Although they have the permits to process hazardous medical waste, not all of them have incinerators.
The organization also found that most medical waste management companies were actually waste transporters.
“Waste processing facilities are still concentrated on Java. A lack of commitment from local administrations, poor oversight and a lack of funds contribute to this problem,” Yuyun said.
There is no evidence so far that direct, unprotected human contact during the handling of healthcare waste has resulted in the transmission of the COVID-19 virus, the World Health Organization (WHO) said in its interim guidelines. The WHO guidelines recommend all medical waste produced during the care of COVID 19 patients be collected safely in designated containers and bags, to be later safely disposed of or treated, preferably onsite. It also recommends that people handling healthcare waste wear appropriate personal protective equipment such as a long-sleeved gown, thick gloves, a mask, goggles and an apron.